Quote:
Originally Posted by laid up doc
janaya -
i will be tested for titanium as well, but it's much less common that nickel or chromium allergies. i am analytical beyond analytical... since i'm unable to work anymore i spend a lot of time doing research, trying to decide what the best thing for me to do is.
if i am not a candidate for a prodisc, i will most likely find the $$ to pay for whichever surgery i think is best, and deal with the appeals after the fact. it costs me a tremendous amnt of $$ not to work (i'm a specialist MD) and my COBRA runs out in May. plus, waiting and fighting aetna will destroy my mental health. also, once i have some resolution then i can proceed w/ the lawsuit - which may in some ways take aetna out of the picture.
i am having a HUGE problem getting a consensus from docs though... one thing that will be a problem should i choose to do an ADR overseas. the 2 docs i saw where i live now both said fusion, that they did adr's and stopped.
i saw a neurosurg in another city (to which i am moving shortly) who just does fusions... and since i am a great ADR candidate as far as my diagnosis, he wanted his partner who does a lot of ADR's to review my case. well, i'm having a lot of trouble even speaking to this dude on the phone. seems once they found out i wasn't a candidate for one of their studies, they weren't interested. apparently most of the insurers in that area don't cover ADR, and they didn't seem to believe me that I had a policy that did. his secretary said some extremely rude things on the phone... i don't know if these are the surgeon's words or hers but it was extraordinarily rude and unprofessional. really turning me off... usually fellow docs don't treat another doc like that, or any medical professional for that matter. ugh.
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Interestingly enough once I found a neurosurgeon in my area that dealt with ADR I thought I was set and said to myself something like: I like how things are now starting to favor my way. THEN I get a call from the neurosurgeon's office and a young lady with perhaps no proper medical training or background-- who I will not name-- blatantly tells me my scheduled Prodisc L procedure is NOT covered. Oh yeah and she tells me this 3 weeks prior to my surgery date! I ask her to substantiate her claim and remains speechless but continues to utter that my policy does not cover the specific procedure. But me, I wasn't really worried. I politely explain to her that she has to be mistaken and is speaking in a general context because I literally must have researched my particular Aetna's policy stance, Clinical Policy Bulletin and all other pertinent info pertaining to my surgery like I was defending my dissertation, and yet despite me literally quoting verbatim information, she turns RUDE and becomes somewhat combative and argumentative--almost to the point of being a snob with me and insists it is not covered. I then just ignored our conversation and told her to go ahead and have her "people" i.e. whatever department handles the formal insurance verification process and get back to me. I think then I became weary and grew doubtful about the practice, and thought to myself, maybe I don't want this practice doing my surgery but overall it was a mere office personnel, in my professional opinion, with no formal training stating what she thought was correct...that in fact MOST insurances don't reimburse/cover intervertebral disc prosthesis surgery! The neurosurgeon on the other hand was tremendous and did an outstanding job! I am starting to wonder if we are dealing with the same people here!
I sincerely do hope and pray that the outcome(s) favor your way too!